Examples of Institutional services in a sentence
Institutional services (i.e., routine home care - 651, continuous home care - 652, inpatient respite care - 655, and general inpatient care - 656) shall be reported on an institutional claim format while hospice physician services (revenue code 657 and accompanying Current Procedural Terminology (CPT) codes) shall be reported on a non-institutional format.
The services that can be sanctioned are: Institutional services which are provided to individuals who are in a nursing facility (NF), intermediate care facility for the mentally retarded (ICF-MR), swing bed or inappropriate level of care bed, Community Alternatives Program (CAP), or the Program of All-Inclusive Care for the Elderly (PACE).
Each LTSS group receives a distinct package of Home and Community-Based Services (HCBS) or Institutional services as described in HAR §17-1720-18 – HCBS or HAR §17-1720-22 – Institutional care.
LOC Determination: Members who will receive HCBS or Institutional services need an approved LOC determination completed on the DHS 1147 form (refer to the “Level of Care and At-Risk Evaluation” appendix in the “Health Plan Manual - Appendices” document).
LTSS Eligibility Determination: In general, Members who meet nursing facility LOC on the DHS 1147 form and want to receive HCBS or Institutional services, will be subject to an asset test and are required to submit an additional LTSS application packet to the DHS eligibility worker (EW) for LTSS eligibility approval.